Depressive Symptoms Predict 12-month Prognosis in Elderly Patients with Acute Myocardial Infarction

Abstract

Background Several studies have associated depressive symptoms with an increased risk for cardiac events after the onset of acute myocardial infarction (AMI). The aim of the present study is to investigate the impact of the depressive symptoms on prognosis of the elderly patients with AMI.Method Depression was assessed in consecutive patients with AMI (n ¼ 1042; mean age 63 7 11 years) using the Zung Self-Rating Depression Scale (SDS). Patient with a score 40 was classified as having depressive symptoms. Cardiac events (cardiac death, nonfatal re-MI, coronary angioplasty or bypass surgery, readmission for heart failure, unstable angina, or uncontrolled arrhythmia) were examined during 12 months follow-up period.Results Depressive symptoms were observed in 438 patients (42.0%). Prevalence of depression was not dependent of age (P ¼ 0.60) and gender (P ¼ 0.91). The rate of cardiac events was 31.2% per year in patients with depressive symptoms whereas 23.9% per year in patients without depressive symptoms. Multiple logistic regression analyses showed that depression was significantly associated with 1-year cardiac events (odds ratio 1.41, 95% CI 1.03 to 1.92, P ¼ 0.03) after controlling for age, gender, severity of myocardial infarction, coronary risk factors, e.g. hypertension, diabetes mellitus and smoking habits. Depression was a significant risk factor for the cardiac events (log rank, P ¼ 0.02) in the elderly patients ( 65 years old, 501 patients). However, the association of depression with cardiac events in the young patients (o 65 years old, 541 patients) was not statistically significant (P ¼ 0.11).Conclusion Depression after AMI is a significant predictor of 1-year cardiac events for Japanese population, and its presence augments the risk especially in the elderly patients.

AAFP Guideline for the Detection and Management of Post-Myocardial Infarction Depression

“…40 The AHRQ EPC report identifi ed 6 independent studies meeting inclusion criteria that reported cardiac event rates among depressed patients. 50,[59][60][61][62][63] Studies were judged to be of moderate quality. One study 50 found that the association between cardiac events and depression disappeared with adjustment for fatigue symptoms, and 2 others found the same when adjusting for a measure of anxiety.…”

CHOICE: Choosing Health Options In Chronic Care Emergencies

“…Sixteen independent prospective studies were identified that had investigated whether or not depression predicted unscheduled care use in patients with either asthma, CHD, COPD or diabetes. 23,24,[28][29][30]55,57,68,[90][91][92][93][94][95][96][97] From the 16 studies, there were data for 8477 patients with LTCs (see Figure 3). Additional records identified through other sources (searching reference lists and citation searching of included papers) (n = 1914) Table 1 summarises the main characteristics of each of the included studies and is adapted from data in the published paper by Dickens et al 78 There were eight studies of COPD, 23,29,30,55,90,[94][95][96] five of CHD, 28,57,[91][92][93] two of asthma 24,68 and only one of diabetes.…”

Impact of depression on sexual dysfunction and HRQoL in CAD patients

“…Even low levels of depressive symptoms not typically associated with depressive disorder predict a 4-month mortality post-MI [10][11][12]. However, major depression following MI is a recognized predictor of disability, poor HRQoL [13][14][15] and mortality in the year post-MI.…”

“…According to BDI score range, patients were divided into 4 groups: minimal (0-13), mild (14)(15)(16)(17)(18)(19), moderate (20)(21)(22)(23)(24)(25)(26)(27)(28) and severe depression (29-63) groups. …”